Bill Summary & Status for the 106th Congress


Sponsor: Rep Thomas, William M. (Bill) (introduced 11/17/1999)
Related Bills: H.R.3075H.R.3194
Latest Major Action: 11/19/1999 See also H.R. 3194. (H.R. 3426 incorporated by cross-reference in the conference report to H.R. 3194) (CR 11/17/1999 H12239, Division B)
Title: To amend titles XVIII, XIX, and XXI of the Social Security Act to make corrections and refinements in the Medicare, Medicaid, and State children's health insurance programs, as revised by the Balanced Budget Act of 1997.
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TITLE(S):  (italics indicate a title for a portion of a bill)
STATUS: (color indicates Senate actions)
Referred to the Committee on Ways and Means, and in addition to the Committee on Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to House Ways and Means
Referred to House Commerce
For Further Action See H.R.3194.
See also H.R. 3194. (H.R. 3426 incorporated by cross-reference in the conference report to H.R. 3194) (CR 11/17/1999 H12239, Division B)

RELATED BILL DETAILS:  (additional related bills may be indentified in Status)







Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 - Title I: Provisions Relating to Part A - Subtitle A: Adjustments to PPS Payments for Skilled Nursing Facilities - Provides that, for computing payments for covered skilled nursing facility (SNF) services furnished under title XVIII (Medicare) of the Social Security Act (SSA) on or after April 1, 2000, and before a described date, the Secretary of Health and Human Services (HHS) shall increase by 20 percent the adjusted Federal per diem rate otherwise determined for covered SNF services for certain RUG-III groups furnished to an individual during the period in which such individual is classified in such an RUG-III category.

(Sec. 101) Provides that for purposes of computing Medicare payments for covered SNF services furnished during FY 2001 and 2002, the Secretary shall increase by four percent for each such fiscal year the adjusted Federal per diem rate. Prohibits the Secretary from including such additional payment in updating the Federal per diem rate.

(Sec. 102) Permits a SNF to elect to have the amount of the payment for all costs of covered SNF services for each day of such services furnished in cost reporting periods beginning no earlier than 30 days before the date of such election.

(Sec. 103) Amends title XVIII to exclude the following items and services from the definition of covered SNF services: (1) ambulance services furnished to an individual in conjunction with renal dialysis services; (2) chemotherapy items identified by the Secretary; (3) chemotherapy administration services; (4) radioisotope services; and (5) customized prosthetic devices.

Directs the Secretary to provide for an appropriate proportional reduction in payments so that beginning with FY 2001, the aggregate amount of such reductions is equal to the aggregate increase in payments.

(Sec. 104) Amends title XVIII to revise provisions on determination of facility specific per diem rates under the prospective payment system (PPS) for SNFs, including adding a specified payment rule for certain facilities.

(Sec. 105) Directs the Secretary to assess the resource use of patients of SNFs furnishing services under Medicare who are immuno-compromised secondary to an infectious disease, with specific diagnoses as specified by the Secretary to determine whether any permanent adjustments are needed to the RUGs to take into account the resource uses and costs of these patients.

(Sec. 106) Directs the Medicare Payment Advisory Commission (MEDPac) to study and report to Congress on SNFs furnishing covered services to determine the need for an additional Medicare payment amount to take into account the unique circumstances of SNFs in Alaska and Hawaii.

(Sec. 107) Directs the Secretary to conduct a study that: (1) identifies variations in State licensure and certification standards for health care providers (including nursing and allied health professionals) and other individuals providing respiratory therapy in SNFs; (2) examines State requirements relating to respiratory therapy competency examinations for such providers and individuals; and (3) determines whether regular respiratory therapy competency examinations or certifications should be required under Medicare for such providers and individuals.

Subtitle B: PPS Hospitals - Amends title XVIII to: (1) modify the formula for the Secretary to provide for an additional payment amount for a disproportionate share hospital (DSH) with indirect costs of medical education; and (2) direct the Secretary to make one or more payments to DSH hospitals which receive payment for the direct costs of medical education for discharges occurring in FY 2000, in an amount according to a specified formula.

(Sec. 112) Decreases reductions in additional payments for DSH and certain other hospitals for FY 2001 and 2002.

Directs the Secretary to require DSH hospitals to submit to the Secretary in their discharge cost reports for a fiscal year data on the costs incurred by the hospital for providing inpatient and outpatient hospital services for which the hospital is not compensated, including non-Medicare bad debt, charity care, and charges for Medicaid (SSA title XIX) and indigent care.

Subtitle C: PPS-Exempt Hospitals - Amends SSA title XVIII to revise provisions on payment to hospitals for inpatient hospital services with respect to the following: (1) a hospital or unit that is within a class of hospital and estimates concerning the target amounts for such hospitals within such class to require the Secretary to provide for an appropriate wage adjustment; (2) determination of the increase in the amount of payment on a per discharge basis for an eligible hospital to alter such determination for psychiatric and long-term care hospitals for specified cost reporting periods beginning on or after October 1, 2000; and (3) PPS for inpatient rehabilitation services.

(Sec. 123) Directs the Secretary to: (1) develop a per discharge PPS for payment for inpatient hospital services of long-term care hospitals; (2) develop a per diem PPS for payment for inpatient hospital services of psychiatric hospitals and units; and (3) study and report to Congress on the impact on utilization and beneficiary access to services of the implementation of the PPS for inpatient hospital services or a rehabilitation hospital or unit.

Subtitle D: Hospice Care - Directs the Secretary to increase the payment rate in effect for hospice care for FY 2001 and 2002. Prohibits the Secretary from using such temporary payment increase when updating the payment rate.

(Sec. 132) Directs the Comptroller General to study and report to Congress on updating the payment rates and the cap for routine home care and other services included in hospice care.

Subtitle E: Other Provisions - Directs MEDPac to study and report to Congress on Medicare policy with respect to professional clinical training of different classes of nonphysician health care professionals and the basis for any differences in treatment among such classes.

Subtitle F: Transitional Provisions - Outlines various transitional provisions applicable to specified geographic areas of the United States and certain health care entities pertaining to: (1) an exception to the Medicare hospital payment case mix index qualifier criteria for classification as a rural referral center; (2) reclassification of certain counties and areas for purposes of Medicare reimbursement; (3) wage index correction; (4) calculation and application of wage index floor; and (5) a special rule for certain SNFs.

Title II: Provisions Relating to Part B - Subtitle A: Hospital Outpatient Services - Revises Medicare requirements for payments to hospitals for inpatient hospital services, among other changes, modifying the following: (1) the PPS for hospital outpatient department (OPD) services with respect to outlier adjustment, transitional pass-through for additional costs of innovative medical devices, transitional adjustment to limit decline, drugs, and biologicals, transitional adjustment to limit decline in payment, the inclusion of certain implantable items under the PPS, and a limitation on outpatient hospital copayment for a procedure to the hospital deductible amount; and (2) amendments by the Balanced Budget Act of 1997 (BBA '97) to provide for an extension of reductions in payments for costs of hospital outpatient services under Medicare.

(Sec. 201) Provides that with respect to determining the total amounts of copayments estimated to be paid to hospitals by Medicare beneficiaries under the PPS for covered OPD services in 1999, as though the deductible did not apply, Congress finds: (1) that such amount should be determined in a budget neutral manner with respect to aggregate payments to hospitals; and (2) that the Secretary has the authority to determine such amount.

Directs the Secretary to study and report to Congress on the extent to which intravenous immune globulin (IVIG) could be delivered and reimbursed under the Medicare program outside of a hospital or a physician's office.

(Sec. 203) Directs MedPAC to study and report to Congress on the appropriateness of providing payments to specified rural and cancer hospitals for covered OPD services based on the PPS established by the Secretary.

Subtitle B: Physician Services - Revises update adjustment factor requirements to reduce update oscillations and mandate estimate revisions for payments for physicians' services.

Directs the Secretary, acting through the Administrator of the Agency for Health Care Policy and Research, to study and report to Congress on specified issues, which include the various methods for accurately estimating the economic impact on expenditures for physicians' services under the original fee-for-service program under Medicare parts A (Hospital Insurance) and B (Supplementary Medical Insurance) resulting from improvements in medical capabilities as well as certain other technological advancements, and demographic and geographic changes.

(Sec. 212) Directs the Secretary to establish by regulation a process (including data collection standards) under which the Secretary will accept for use and will use data collected or developed by non-HHS entities and organizations to supplement the data normally collected by HHS in determining the practice expense component for determining relative values for payment for physicians' services under the Medicare fee schedule.

(Sec. 213) Directs the Comptroller General to study and report to Congress on the physician and non-physician clinical resources necessary to provide safe outpatient cancer therapy services and the appropriate payment rates for them under Medicare.

Subtitle C: Other Services - Revises requirements for payment of benefits certain physical and occupational therapy services under Medicare part B to exempt expenses considered as incurred by an individual from the cap on such expenses for calendar years 2000 and 2001.

(Sec. 221) Directs the Secretary to conduct focused medical reviews of claims for certain services provided to residents of SNFs.

Directs the Secretary to study and to report to Congress on utilization policies for outpatient physical and occupational therapy services.

(Sec. 222) Amends SSA title XVIII to direct the Secretary to increase the amount of each composite rate payment for dialysis services: (1) furnished during 2000 by 1.2 percent above such composite rate payment amounts for such services furnished on December 31, 1999; and (2) for such services furnished on or after January 2001, by 1.2 percent above such composite rate payment amounts for such services furnished on December 31, 2000.

Requires MEDPac to study and report to Congress on the appropriateness of the differential in payment under Medicare for hemodialysis services furnished in a facility and for such services furnished in a home.

(Sec. 223) Prohibits the Secretary from using, or permitting fiscal intermediaries or carriers to use, certain inherent reasonableness authority with respect to use of carriers for administration of benefits until after: (1) the Comptroller General releases a specified report on the impact of the Secretary's, fiscal intermediaries', and carriers' use of such authority; and (2) the Secretary has published in the Federal register a notice of final rulemaking relating to such authority in response to such report.

(Sec. 224) Amends SSA title XVIII to direct the Secretary to establish a national minimum payment amount of $14.60, adjusted annually, for a diagnostic or screening pap smear laboratory test.

Expresses the sense of Congress that: (1) the Health Care Financing Administration (HCFA) has been slow to incorporate or provide incentives for providers to use new screening diagnostic health care technologies in the area of cervical cancer; (2) some new technologies have been developed which optimize the effectiveness of pap smear screening; and (3) HCFA should institute an appropriate increase in the payment rate for such technologies that have been approved by the Food and Drug Administration, and that are significantly more effective than a conventional pap smear.

(Sec. 225) Amends BBA '97 to with respect to demonstration of Medicare coverage of ambulance services through contracts with units of local government, revising the definition of capitated payment rate.

(Sec. 226) Provides for the phase-in of a PPS for ambulatory surgical centers.

(Sec. 227) Amends SSA title XVIII to provide for the extension of immunosuppressive drug coverage for individuals who would otherwise exhaust their Medicare benefits for prescription drugs used in immunosuppressive therapy.

Provides that national coverage determinations under Medicare part C (Medicare+Choice) benefits and beneficiary protections provisions shall apply with respect to the coverage of additional benefits for immunosuppressive drugs for drugs furnished in 2000 in the same manner as if the amendments of this Act constituted a national coverage determination.

(Sec. 228) Directs the Secretary to increase the payment amount for durable medical equipment and medical supplies (including oxygen) for 2001 and 2002.

(Sec. 229) Directs MEDPac to study and report to Congress on: (1) post-surgical recovery care center services; and (2) regulatory burdens placed on all classes of health care providers under Medicare parts A and B, and on the costs these burdens impose on the nation's health care system.

Requires the Administrator for Health Care Policy and Research to provide for a study and report to Congress on the effect of credentialing of technologists and sonographers on the quality of ultrasound under Medicare and Medicaid.

Direct the Comptroller General to continue monitoring Department of Justice compliance with certain guidelines on the use of the False Claims Act in civil health care matters for reports to Congress.

Title III: Provisions Relating to Parts A and B - Subtitle A: Home Health Services - Provides that, in the case of a home health agency that furnishes home health services to a Medicare beneficiary, for each such beneficiary to whom the agency furnished such services during the agency's cost reporting period beginning in FY 2000, the Secretary shall pay the agency for the beneficiary and only for such cost reporting period, an aggregate additional amount of $10 to defray costs attributable to data collection and reporting requirements under the Outcome and Assessment Information Set (OASIS) required by BBA '97. Requires: (1) the Secretary to pay to a home health agency an amount estimated to be 50 percent of the aggregate amount payable to the agency by reason of this subtitle; and (2) payments under this subtitle to be made, in appropriate part as specified by the Secretary, from Medicare trust funds.

(Sec. 301) Requires the Comptroller General to: (1) report to Congress on specified matters with respect to the data collection requirement of patients of home health agencies under the OASIS standard as part of the comprehensive assessment of patients; and (2) conduct an independent audit of, and report to Congress on, the costs incurred by Medicare home health agencies in complying with such data collection requirement.

(Sec. 302) Amends BBA' 97 to eliminate the scheduled automatic 15 percent reduction in payment amounts to home health agencies furnishing home health services under the Medicare program.

Amends SSA title XVIII to provide for a delay in application of the 15 percent reduction in payment rates for home health services until one year after implementation of the PPS for home health services.

Requires the Secretary to report to Congress on the need for the 15 percent reduction or for any reduction in the computation of the base payments under such PPS.

(Sec. 303) Amends SSA title XVIII to provide for an increase in the agency-specific per beneficiary annual limitation under the interim system of limits for home health agencies furnishing home health services. Excludes such increase from the home health services PPS base.

(Sec. 304) Revises surety bond requirements under home health agencies provisions, requiring such agencies to provide the Secretary with a surety bond: (1) that is effective for a period of four years; and (2) for a year in such period in an amount that is equal to the lesser of $50,000 or ten percent of the aggregate amount of payments to the agency under Medicare and Medicaid for that year, as estimated by the Secretary.

Amends part A (General Provisions) of SSA title XI to provide for coordination of surety bonds under Medicare and Medicaid.

(Sec. 305) Amends SSA title XVIII to include medical supplies as home health services for purposes of consolidated billing.

(Sec. 307) Directs MEDPac to study and report to Congress on the feasibility and advisability of exempting from payment under the PPS for such services any home health services provided by a home health agency (or by others under arrangements with such agency) located in a rural area, or to an individual residing in a rural area.

Subtitle B: Direct Graduate Medical Education - Amends SSA title XVIII to provide for the use of national average payment methodology in computing direct graduate medical education (DGME) payments.

(Sec. 312) Makes the initial residency period for child neurology residency training programs the period of board eligibility for pediatrics plus two years.

Directs MEDPac to include in its report to Congress in March of 2001 recommendations regarding the appropriateness of the initial residency period used for other residency training programs in a specialty that require preliminary years of study in another specialty.

Subtitle C: Technical Corrections - Makes various specified technical corrections to BBA '97 and the Health Insurance Portability and Accountability Act of 1996 codified in SSA title XVIII.

(Sec. 321) Amends SSA title XI to repeal provisions on the development of model prospective rate methodology.

Title IV: Rural Provider Provisions - Subtitle A: Rural Hospitals - Amends SSA title XVIII with respect to payment to hospitals for inpatient hospital services to: (1) permit reclassification of certain urban hospitals as rural hospitals; and (2) add standards applied for geographic reclassification for certain hospitals for cost reporting periods beginning in a fiscal year before FY 2003 and after FY 2002.

(Sec. 403) Revises requirements for the Medicare critical access hospital program to: (1) apply on an annual, average basis the 96-hour limit on providing inpatient care; (2) permit for-profit hospitals to qualify for designation as a critical access hospital; (3) allow closed or downsized hospitals to convert to critical access hospitals; (4) provide for election of cost-based payment option for outpatient critical access hospital services; and (5) eliminate coinsurance for clinical diagnostic laboratory tests furnished by a critical access hospital on an outpatient basis.

(Sec. 404) Provides, with respect to payment to hospitals for inpatient hospital services, for: (1) extending for five years the payment methodology for Medicare-dependent, small rural DSH hospitals; (2) rebasing for certain sole community hospitals; (3) providing for a full market basket percentage increase for FY 2001 for sole community hospitals; and (4) increasing flexibility in providing graduate physician training in rural and other areas.

(Sec. 408) Amends SSA title XVIII with regard to hospital providers of extended care services to eliminate: (1) the requirement for the hospital to have a certificate of need from the State in order to provide long-term care services; and (2) eliminate "swing bed" restrictions on certain hospitals with more than 49 beds.

(Sec. 409) Amends SSA title XVIII with regard to the Medicare rural hospital flexibility program to authorize the Secretary to assist eligible small rural hospitals in meeting the costs of implementing data systems required to meet requirements established under Medicare pursuant to BBA '97 requirements for implementation of PPSs.

(Sec. 410) Directs the Comptroller General to study and report to Congress on the current laws and regulations for geographic reclassification of hospitals to determine if such reclassification: (1) is appropriate for applying wage indices under Medicare; and (2) results in more accurate payments for all hospitals.

Subtitle B: Other Rural Provisions - Directs MEDPac to study and report to Congress on rural providers furnishing items and services for which payment is made under Medicare.

(Sec. 412) Amends BBA '97 to provide for: (1) expanding access to paramedic intercept services in rural areas; and (2) promoting prompt implementation of the informatics, telemedicine, and education demonstration project.

Title V: Provisions Relating to Part C (Medicare+Choice Program) and Other Medicare Managed Care Provisions - Subtitle A: Provisions to Accommodate and Protect Medicare Beneficiaries - Amends SSA title XVIII parts C and D (Miscellaneous) with respect to Medicare+Choice enrollment rules to permit enrollment in alternative Medicare+Choice plans and Medicare supplemental health insurance (Medigap) policies coverage in case of involuntary termination of Medicare+Choice enrollment.

(Sec. 502) Amends SSA title XVIII part C to revise the effective date of elections and changes of elections of Medicare+Choice eligible individuals who make such elections after the tenth day of the month.

(Sec. 503) Amends SSA title XVIII part D to extend Medicare cost contracts by two years.

Subtitle B: Provisions to Facilitate Implementation of the Medicare+Choice Program - Amends title XVIII part C to require the Secretary to phase-in, according to a specified schedule, the implementation of a risk adjustment methodology (in calculating payments to Medicare+Choice organizations) that accounts for variations in per capita costs based on health status and other demographic factors for payments.

(Sec. 511) Directs MEDPac to study specified related issues and report to Congress on the methodology used by the Secretary in developing the risk factors used in adjusting the Medicare+Choice capitation rate paid to Medicare+Choice organizations.

Directs the Secretary to study and report to Congress on how to reduce the costs and burdens on Medicare+Choice organizations of compliance with reporting requirements for encounter data imposed by the Secretary in establishing and implementing a risk adjustment methodology.

(Sec. 512) Amends SSA title XVIII part C to: (1) provide for a new entry bonus increasing the amount of monthly payment otherwise made to Medicare+Choice organizations in order to encourage the offering of Medicare+Choice plans in certain payment areas without plans; (2) reduce from five to two years the general exclusion period following a Medicare+Choice organization's contract termination; (3) require the continued computation and annual publication of Medicare original fee-for-service expenditures for each Medicare+Choice payment area; (4) direct the Secretary to permit a Medicare+Choice organization to elect to apply Medicare+Choice premiums provisions uniformly to separate segments of a service area (rather than uniformly to an entire service area) as long as such segments are composed of one or more Medicare+Choice payment areas; (5) delay the deadline for submission of proposed premiums and related information each Medicare+Choice organization is required to submit to the Secretary for each Medicare+Choice plan for the service area in which it intends to be offered in the following year; (6) reduce the adjustment in the national per capita Medicare+Choice growth percentage for 2002 with respect to calculation of annual Medicare+Choice capitation rates; (7) make additional requirements that a Medicare+Choice organization may be deemed to meet under specified circumstances if it is privately accredited; (8) change the timing of Medicare+Choice health information fairs; (9) require preferred provider organization plans to meet certain of the quality assurance requirements currently applicable to Medicare+Choice plans; and (10) include the average number of individuals enrolled in Medicare+Choice plans during the fiscal year within the formula limiting the amount of user fees collected by the Secretary in any fiscal year from each Medicare+Choice organization under contract with the Secretary.

(Sec. 520) Directs MEDPac to study and report to Congress on appropriate quality improvement standards that should apply to: (1) described Medicare+Choice plans, including coordinated care plans; and (2) the original Medicare fee-for-service program under Medicare parts A and B.

(Sec. 521) Amends SSA title XVIII part D to provide that, in the case of a discharge plan for an individual enrolled with a Medicare+Choice organization under a Medicare+Choice plan who is furnished inpatient hospital services by a hospital under a contract with the organization, the discharge planning evaluation is not required to include information on the availability of home health services through individuals and entities which do not have a contract with the organization. Allows the plan to specify or limit the provider or providers of post-hospital home health services or other post-hospital services under the plan.

(Sec. 524) Amends SSA title XVIII part D to exempt a Medicare+Choice organization offering a coordinate care plan from the limitation on certain physician referrals.

Subtitle C: Demonstration Projects and Special Medicare Populations - Amends the Omnibus Budget Reconciliation Acts of 1987 and of 1993 to: (1) extend the authority for the social health maintenance organizations (SHMOs) demonstration project; and (2) authorize the Secretary to impose an aggregate limit of not less than 324,000 for all sites (currently, the Secretary is prohibited from imposing a limit of less than 12,000 on the number of individuals that may participate in a single project site.)

(Sec. 532) Extends certain Medicare community nursing organization demonstration projects an additional two years.

(Sec. 533) Amends BBA '97 to provide for a delay in implementation of the Medicare+Choice competitive bidding demonstration project.

(Sec. 534) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended by BBA '97 and other specified Acts, to extend for two years the Medicare municipal health services demonstration projects.

(Sec. 535) Amends BBA '97 with regard to Medicare coordinated care demonstration projects to direct the Secretary to provide for the transfer from the Medicare trust funds, in appropriate proportions, of such funds as necessary to cover costs of the project in a cancer hospital. (Currently amounts shall be available for such hospitals only as provided in any Federal law making appropriations for the District of Columbia).

(Sec. 536) Amends SSA title XVIII part D to extend to enrollees in programs of all-inclusive care for the elderly (PACE programs) the Medigap prohibitions on denial of issuance of Medigap policies, discrimination in policy pricing, and imposition of an exclusion of benefits based on a pre-existing condition.

Subtitle D: Medicare+Choice Nursing and Allied Health Professional Education Payments - Amends SSA title XVIII part D to provide for: (1) payment for nursing and allied health education for managed care enrollees; and (2) adjustments in payments for direct graduate medical education. Directs the Secretary to estimate a proportional adjustment in payments for nursing and allied health education.

Subtitle E: Studies and Reports - Directs the Secretary, jointly with the Secretaries of Defense and of Veterans Affairs, to report to Congress on the estimated use of health care services furnished to Medicare beneficiaries by the Departments of Defense and of Veterans Affairs, including beneficiaries under the original Medicare fee-for-service program and under the Medicare+Choice program.

(Sec. 552) Directs MEDPac to study and report to Congress on the development of a payment methodology under the Medicare+Choice program for frail elderly beneficiaries enrolled in a Medicare+Choice plan under a specialized program.

Directs MEDPac to report to Congress on specific legislative changes that should be made to make Medical Savings Account plans a viable option under the Medicare+Choice program.

(Sec. 553) Directs the Comptroller General to study and report to Congress on each type of Medigap policy with respect to: (1) the level of coverage provided; (2) current enrollment levels; (3) policy availability to Medicare beneficiaries over age 65 <; (4) the number and type of Medigap policies offered in each State; and (5) the average out-of-pocket costs (including premiums) per beneficiary.

Directs the Comptroller General to: (1) conduct an annual audit of the Secretary's expenditures during the preceding year in providing information regarding the Medicare+Choice program to eligible Medicare beneficiaries; and (2) report to Congress on the results of such audits of the preceding three years, together with an evaluation of the effectiveness of the means used by the Secretary in providing such information.

Title VI: Medicaid - Amends SSA title XIX (Medicaid) to: (1) increase the DSH allotment for the District of Columbia, Minnesota, New Mexico, and Wyoming; (2) remove the fiscal year limitation on certain transitional administrative costs assistance; (3) modify the phase-out of payment for Federally-qualified health center services and rural health clinic services based on reasonable costs; (6) provide for parity in reimbursement for certain utilization and quality control services; (7) eliminate duplicative requirements for external quality review of Medicaid managed care organizations; (8) make the enhanced match under the State Children's Health Insurance Program (SCHIP) inapplicable to Medicaid DSH payments; and (9) provide for the optional deferment of the effective date for outpatient drug agreements.

(Sec. 603) Directs the Comptroller General to report to Congress on the effect on Federally-qualified health centers and rural health clinics and on the populations served by such centers and clinics of the phase-out and elimination of the reasonable cost basis for payment for Federally-qualified health center services and rural health clinic services provided.

Amends BBA '97 to make the Medicaid DSH transition rule permanent.

Title VII: State Children's Health Insurance Program (SCHIP) - Amends SSA title XXI (State Children's Health Insurance Program) (SCHIP) to revise the SCHIP allotment formula, among other changes revising the floor for State allotments and adding ceilings.

(Sec. 702) Increases appropriations for FY 2000 through 2007 for U.S. territories with approved SCHIP plans.

(Sec. 703) Directs the Secretary of Commerce to make appropriate adjustments to the annual Current Population Survey conducted by the Bureau of the Census in order to produce statistically reliable annual State data on the number of low-income children without health insurance coverage, so that real changes in the uninsurance rates of children can reasonably be detected. Makes appropriations.

Requires the HHS Secretary to conduct an independent evaluation of ten select States with approved child health plans, including surveys of enrollees, disenrollees, and individuals eligible for but not enrolled in SCHIP, and evaluation of effective and ineffective outreach and enrollment practices with respect to children. Makes appropriations for FY 2000. Directs the Secretary to audit a sample from among States with an approved State child health plan to: (1) determine the number of plan enrollees eligible under Medicaid (other than as optional targeted low-income children; and (2) assess the progress made in reducing the number of uncovered low-income children, including the progress made to achieve the strategic objectives and performance goals in the State child health plan.

Amends SSA title V (Maternal and Child Health Services) to require each State's annual reports to the Secretary on its activities under such title to include information (by racial and ethnic group) on the number of infants in the State under one year of age who were entitled to benefits under the State SCHIP plan at any time during the year.

Directs the Secretary to establish a clearinghouse for the consolidation and the coordination of all Federal databases and reports regarding children's health.

(Sec. 704) Directs the Secretary or any other Federal officer or employee, with respect to any reference to the program under SSA title XXI in any publication or other official communication to use the term "SCHIP" instead of "CHIP" and the term "State's children's health insurance program" instead of the term "children's health insurance program."